Jang T N, Wang F D, Wang L S, Liu C Y, Liu I M
Department of Medicine, National Yang-Ming Medical College, Taipei, Taiwan, R.O.C.
J Formos Med Assoc. 1992 Dec;91(12):1170-6.
Thirty-two cases of Xanthomonas maltophilia bacteremia have been identified over the last two years at the Veterans General Hospital, Taipei. Among them, 27 cases (84%) were due to hospital-acquired infections, and 14 cases (44%) were polymicrobial bacteremia. One case was confirmed as prosthetic valve endocarditis and one case was complicated by recurrent attacks of ecthyma gangrenosum. Most cases had severe debilitating conditions. Twelve cases (38%) had a malignancy, 19 cases (59%) were resident in the Intensive Care Unit and 16 cases (50%) had undergone major surgery. The main predisposing factors included central venous catheterization, endotracheal intubation or tracheostomy, prior antibiotic therapy and prolonged hospitalization. Moxalactam, chloramphenicol and trimethoprim-sulfamethoxazole were the most effective agents in vitro against X. maltophilia. Twenty-two cases (69%) died during hospitalization; 13 cases (41%) were directly attributed to septicemia. Factors that adversely influenced mortality included inappropriate antimicrobial therapy and prior antibiotic treatment. Of particular interest is the fact that none of the patients who did not receive appropriate antimicrobial therapy survived. Early diagnosis and appropriate antibiotic therapy are critical for improving the prognosis of X. maltophilia infection.
过去两年间，台北荣民总医院共确诊32例嗜麦芽窄食单胞菌血症。其中，27例（84%）为医院获得性感染，14例（44%）为 polymicrobial 菌血症。1例确诊为人工瓣膜心内膜炎，1例并发坏疽性脓皮病反复发作。多数病例存在严重的衰弱状况。12例（38%）患有恶性肿瘤，19例（59%）入住重症监护病房，16例（50%）接受过大手术。主要的易感因素包括中心静脉置管、气管插管或气管切开、先前的抗生素治疗以及长期住院。羟羧氧酰胺菌素、氯霉素和复方新诺明是体外抗嗜麦芽窄食单胞菌最有效的药物。22例（69%）在住院期间死亡；13例（41%）直接归因于败血症。对死亡率产生不利影响的因素包括抗菌治疗不当和先前的抗生素治疗。特别值得注意的是，未接受适当抗菌治疗的患者无一存活。早期诊断和适当的抗生素治疗对于改善嗜麦芽窄食单胞菌感染的预后至关重要。
